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Download Monthly Resource: Common Medication Laboratory Monitoring
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Common Medication Laboratory Monitoring Based on the CMS State Operations Manual The Centers of Medicare and Medicaid Services (CMS) has outlined guidance for medication monitoring within section F-329 Unnecessary Medications in the State Operations Manual. Below is a summary of the recommended laboratory monitoring parameters for common medications in the geriatric population. Keep in mind this is only a general guide to monitoring; each care plan will vary depending on the condition and the needs of each individual resident. Clinically complex residents may require more frequent or additional monitoring, while a stable resident may require less. To see the full CMS guidance, please refer to Table 1 in F-329 starting on page 371 in the CMS State Operations Manual (see references). Medications ACE-Inhibitors and ARBs Labs Serum potassium Acetaminophen Amiodarone LFTs LFTs, CBC, TSH Monitoring Interval Baseline, within in first month, and every 6 months Every 3 months Every 6 months Anticonvulsants: Carbamazepine Phenytoin Phenobarbital Primidone Divalproex sodium Valproic acid Antidiabetics Insulin Oral hypoglycemics Serum medication levels Every 6 months Serum glucose (point of care), Hemoglobin A1c Metformin – monitor serum creatinine Antifungals Imidazoles (systemic) Increased monitoring with concomitant drug use: Warfarin (PT/INR) Phenytoin (serum levels) Theophylline (serum levels) Sulfonylureas (FBG) FLP, Hemoglobin A1c Every 6 months (A1c); more frequently for glucose monitoring Based on interacting medications and clinical conditions Every 6 months If used to manage behavior, stabilize mood, or treat psychiatric disorders, refer to GDR guidance Antipsychotics Monthly Resource / Oct 2015 Comments Also, monitor serum creatinine and BUN at initiation and regularly Only for doses >4 grams/day Also requires annual eye exam, EKG, and PFTs If used to manage behavior, stabilize mood, or treat psychiatric disorders, refer to Gradual Dose Reduction guidance (GDR) Medications Digoxin Labs Serum digoxin level, BMP Monitoring Interval Every 6 months Diuretics BMP Fibrates Lithium CBC, LFTs Serum lithium level Within the first month and every 6 months Every 6 months Every 3 months Nitrofurantoin Serum creatinine Prior to initiation Niacin LFTs, serum glucose Every 6 months Non-Steroidal AntiInflammatory Drugs Selective Serotonin Reuptake Inhibitors CBC, serum creatinine Every 6 months Exception: aspirin 81mg daily Serum sodium Monitor mood and refer to GDR guidance as well Statins LFTs Thyroid Medications Levothyroxine Liothyronine Urinary Anti-Infective TSH, T4 Warfarin PT/INR Baseline, dose increases, and annually Baseline, 12 weeks post-initiation, and every 6 months Baseline, at least 6-8 weeks after initiation or dose changes Required within 30 days of starting therapy Based on clinical circumstance; at least every 4 weeks Key: BMP: Basic metabolic panel CBC: Complete blood count C&S: Culture and sensitivity FLP: Fasting lipid panel UA and C&S Comments Narrow therapeutic window; increased monitoring with drug interactions Do not use for CrCL <60ml/min (SOM) or <40ml/min Monitor FLP for efficacy at least annually T3 (instead of T4) should be monitored for liothyronine Prophylaxis medication is discouraged Checked more frequently with changes interacting medications LFTs: Liver function tests PT/INR: Prothrombin time/International normalized ratio TSH: Thyroid stimulating hormone UA: Urinalysis References: 1. State Operations Manual. Centers of Medicare and Medicaid Services. Available at: https://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/downloads/R22SOMA.pdf Accessed Sept 2015. 2. Laboratory Monitoring Interval (in Months) Recommended for Chronic Medications, Table 2: Consult Pharm. 2008 May; 23(5): 387–395. Monthly Resource / Oct 2015
